Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network
2024
Buetti, Niccolò | Zahar, Jean-Ralph | Adda, Mireille | Ruckly, Stéphane | Bruel, Cédric | Schwebel, Carole | Darmon, Michael | Adrie, Christophe | Cohen, Yves | Siami, Shidasp | Laurent, Virginie | Souweine, Bertrand | Timsit, Jean-François | Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord | Hôpitaux universitaires de Genève = University Hospitals of Geneva (HUG) | Hôpital Avicenne [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | CHU Clermont-Ferrand | Outcome Réa (Outcomerea) | Centre hospitalier Saint-Joseph [Paris] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Centre Hospitalier Universitaire [CHU Grenoble] (CHUGA) | Service de biostatistique et information médicale de l’hôpital Saint Louis (Equipe ECSTRA) (SBIM) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut national du cancer (INCa)-Hopital Saint-Louis [AP-HP] (AP-HP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité) | Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques (CRESS (U1153 / UMR_A 1125)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | Hôpital Delafontaine ; Centre Hospitalier de Saint-Denis [Ile-de-France] | Centre Hospitalier Sud Essonnes Dourdan Etampes | Centre Hospitalier de Versailles André Mignot (CHV) | Services de Maladies Infectieuses et Tropicales [CHU Bichat] ; AP-HP - Hôpital Bichat - Claude Bernard [Paris] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | OUTCOMEREA Network: Jean-François Timsit, Elie Azoulay, Maïté Garrouste-Orgeas, Jean-Ralph Zahar, Bruno Mourvillier, Michael Darmon, Niccolò Buetti, Jean-Francois Timsit, Corinne Alberti, Stephane Ruckly, Sébastien Bailly, Aurélien Vannieuwenhuyze, Christophe Adrie, Carole Agasse, Bernard Allaouchiche, Olivier Andremont, Pascal Andreu, Laurent Argaud, Elie Azoulay, Francois Barbier, Jean-Pierre Bedos, Jérome Bedel, Asael Berger, Julien Bohé, Lila Bouadma, Jeremy Bourenne, Noel Brule, Frank Chemouni, Julien Carvelli, Martin Cour, Michael Darmon, Julien Dessajan, Claire Dupuis, Etienne de Montmollin, Marc Doman, Loa Dopeux, Anne-Sylvie Dumenil, Claire Dupuis, Jean-Marc Forel, Marc Gainnier, Charlotte Garret, Louis-Marie Galerneau, Dany Goldgran-Tonedano, Steven Grangé, Antoine Gros, Hédia Hammed, Akim Haouache, Tarik Hissem, Vivien Hong Tuan Ha, Sébastien Jochmans, Jean-Baptiste Joffredo, Hatem Kallel, Guillaume Lacave, Virgine Laurent, Alexandre Lautrette, Clément Le Bihan, Virgine Lemiale, David Luis, Guillaume Marcotte, Jordane Lebut, Bruno Mourvillier, Benoît Misset, Bruno Mourvillier, Mathild Neuville, Laurent Nicolet, Johanna Oziel, Laurent Papazian, Juliette Patrier, Benjamin Planquette, Aguila Radjou, Marie Simon, Romain Sonneville, Jean Reignier, Bertrand Souweine, Carole Schwebel, Shidasp Siami, Romain Sonneville, Michael Thy, Gilles Troché, Fabrice Thiollieres, Guillaume Thierry, Michael Thy, Guillaume Van Der Meersch, Marion Venot, Florent Wallet, Sondes Yaacoubi, Olivier Zambon, Jonathan Zarka, Kévin Grapin, Francois Thouy, Laure Calvet, Kevin Grapin, Guillaume Laurichesse, Martin Cour, Neven Stevic, Mireille Adda, Vanessa Vindrieux, Marion Provent, Pauline Enguerrand, Vincent Gobert, Stéphane Guessens, Helene Merle, Nadira Kaddour, Boris Berthe, Samir Bekkhouche, Kaouttar Mellouk, Mélaine Lebrazic, Carole Ouisse, Diane Maugars, Christelle Aparicio, Igor Theodose, Manal Nouacer, Veronique Deiler, Fariza Nait Sidenas, Myriam Moussa, Atika Mouaci, Nassima Viguier.
International audience
Afficher plus [+] Moins [-]anglais. Purpose: This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture.Methods: We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality.Results: We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73).Conclusions: Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.
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